1
|
Tseng WY, Lai MW, Lai JY, Chen CC, Chao HC, Chen JC, Chen SY, Ming YC, Yeh HY, Lai HH, Ting SY, Yeh PJ. Twenty years' experience of midgut malrotation and volvulus in a tertiary center in northern Taiwan: A retrospective study. Pediatr Neonatol 2024:S1875-9572(24)00051-2. [PMID: 38679520 DOI: 10.1016/j.pedneo.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Early diagnosis and surgical intervention for midgut malrotation with bowel obstruction are crucial. We aimed to identify risk factors for adverse outcomes in infants with midgut malrotation and to develop a prediction model. METHODS We reviewed the operation records of infants surgically diagnosed with midgut malrotation at Chang Gung Children's Medical Center between January 2000 and December 2020. Patients were classified into the poor-outcome group (PO) if they underwent bowel resection or experienced mortality; all others were categorized as the favorable-outcome group (FO). Data on demographics, initial presentations, laboratory results, radiographic or sonographic findings, maternal conditions, and outcomes were collected and analyzed. Fisher's exact test, the independent sample t-test, and the Mann-Whitney test were utilized for comparative analysis when suitable. RESULTS The study included 103 infants. Eleven were in the PO group, and 92 were in the FO group. Initial presentations such as respiratory distress, poor activity, and shock status were notably more prevalent in the PO group. The INR, hemoglobin, HCO3, base excess, and aspartate transaminase values showed significant variation between the two groups. Multivariate analysis identified that lower hemoglobin (OR 0.677, p = 0.043) and higher AST (OR 1.036, p = 0.044) were independent predictors of adverse outcomes. An AST/Hb ratio of <3.78 demonstrated a high negative predictive value (98.6%) for an adverse outcome in midgut malrotation. CONCLUSIONS Prompt diagnosis and surgical treatment of midgut malrotation are vital to prevent bowel resection or mortality. The independent predicting factors for poor outcomes include low hemoglobin and elevated AST levels.
Collapse
Affiliation(s)
- Wen-Yu Tseng
- Department of Pediatrics, Jen Ai Hospital, Dali Branch, No. 483, Dongrong Rd., Dali Dist., Taichung City, 412, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan; College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chien-Chang Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan; College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Hsun-Chin Chao
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan; College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Shih-Yen Chen
- Department of Pediatrics, Ministry of Health and Welfare Shuang-Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Hung-Yu Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Hung-Hsiang Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Sze-Ya Ting
- Department of Pediatric Surgery, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Pai-Jui Yeh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| |
Collapse
|
2
|
Landolsi S, Youssfi R, Trabelsi M, Touati D, Saidi A, Chebbi F. Exceptional vascular variants during oncological right colectomy: Case reports. Int J Surg Case Rep 2023; 111:108853. [PMID: 37742356 PMCID: PMC10520797 DOI: 10.1016/j.ijscr.2023.108853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/16/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Carcinological right colectomy with complete D3 mesocolon excision has to be guided by vascular variants in order to avoid complications especially in exceptional cases as illustrated by our two cases. CASE PRESENTATIONS Two women had right colectomies with compete D3 mesocolon excision via laparotomy for right colon tumors with a non-modal anatomy: an X-shaped relationship between the superior mesenteric artery and the superior mesenteric vein and a Y-shaped superior mesenteric vein, an ileocolic artery behind the two trunks, a right colic artery behind the left trunk, and the middle colic artery anterior to the main trunk of the superior mesenteric vein respectively. DISCUSSION Our cases illustrated extremely rare vascular variants during right colectomy with complete mesocolic excision. These variants should be identified based on the computed tomography with coronal reconstructions allowing to guide surgical procedure before the operating room in order to anticipate per-operative difficulties and reduce morbidity. CONCLUSIONS Vascular anatomical study based on computed tomography with coronal reconstructions was mandatory before right colectomy with complete mesocolic excision and D3 lymphadenectomy.
Collapse
Affiliation(s)
- Sana Landolsi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Rahma Youssfi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Mehdi Trabelsi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Dhaker Touati
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Aymen Saidi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- University of Tunis El Manar, Faculty of medicine of Tunis, Department of surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| |
Collapse
|
3
|
Coco D, Leanza S. Vascular Anatomy and Variants: Knowledge during Laparoscopic Right Colectomy. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
From the review of the literature and clinical data, it is clear that the anatomy of the vessels of the right colon is remarkably variable, especially those of Henle branch. This justifies why the laparoscopic colectomy (LRC) plus complete mesocolon excision (CME) is often difficult to perform with the conversion rate due to the lesion of the vessels. The objective of this study was to retrospectively review the videos and literature of the right laparoscopic colectomy plus CME to highlight the greatest number of vascular variations of the right colon, to record them, and to highlight the methods by which cope with these variations during surgery.
Collapse
|
4
|
Fogam M, Leigh N, She T. Whirlpool No More: A Case of Misdiagnosed Malrotation with Midgut Volvulus. Clin Pract Cases Emerg Med 2021; 5:463-465. [PMID: 34813445 PMCID: PMC8610483 DOI: 10.5811/cpcem.2021.9.52682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/20/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Adult intestinal malrotation with midgut volvulus is rare and most often diagnosed on abdominal imaging. Once the diagnosis is made, prompt surgical intervention is necessary. A finding suggestive of malrotation with midgut volvulus on abdominal imaging is the "whirlpool" sign where the superior mesenteric vein and superior mesenteric artery twist at the root of the abdominal mesentery. This sign was once thought to be pathognomonic, but recent studies have shown that it can be seen in asymptomatic patients. CASE REPORT A 20-year-old female presented to our emergency department with diffuse abdominal pain. Computed tomography demonstrated the "whirlpool" sign with a concern for malrotation with midgut volvulus. Surgical consultation was obtained and the patient was rushed to the operating room for an exploratory laparotomy. Normal mesenteric attachments were seen and no significant pathology was identified during the laparotomy. The patient was eventually diagnosed with gastritis and discharged in stable condition. CONCLUSION Emergency physicians and surgeons alike should be cautious in confirming malrotation with midgut volvulus solely due to the "whirlpool" sign on abdominal imaging. Premature diagnostic closure can lead to unnecessary procedures and interventions for patients as in the case we report here.
Collapse
Affiliation(s)
- Michael Fogam
- Mount Sinai St. Luke's and Mount Sinai West, Department of Emergency Medicine, New York, New York
| | - Natasha Leigh
- Mount Sinai St. Luke's and Mount Sinai West, Department of Surgery, New York, New York
| | - Trent She
- Mount Sinai St. Luke's and Mount Sinai West, Department of Emergency Medicine, New York, New York
| |
Collapse
|
5
|
A comprehensive radiologic review of abdominal and pelvic torsions. Abdom Radiol (NY) 2021; 46:2942-2960. [PMID: 33388807 DOI: 10.1007/s00261-020-02868-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.
Collapse
|
6
|
Alamdaran SA, Mahdavi Rashed M, Arjmand S, Rahimzadeh Oskooei R. Mesenteric Vessel Abnormalities Detected With Sonography: A Possible Gateway to the Early Diagnosis of Various Gastrointestinal Anomalies. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320961076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In pediatric sonography, mesenteric vessel abnormalities can be used as a sign of malrotation or volvulus. This study was aimed at evaluating the diseases associated with mesenteric vessel abnormalities in children, except for rotational anomalies. Methods: From 2017 to 2020, pediatric patients with abdominal complaints were referred for a full abdominal sonogram and were evaluated for mesenteric vascular abnormalities. During this period, 62 children (aged <12 years), with mesenteric vessel abnormalities, were discovered with sonography. They were also examined for associated anomalies and were followed until a final diagnosis was determined. Results: Mesenteric vessel displacement was reported in 37 patients (60%); in 24 cases, the vein was located to the left of superior mesenteric artery (SMA), and in others (13 cases), in the anterior position. Abnormal pathways in mesenteric vessels were reported in 33 patients (53%); 18 cases showing a right side turn and 15 cases showing a left side turn. The whirlpool sign was seen in 16 patients (27%). These three patterns of vessel abnormality were associated with disorders such as diaphragmatic hernia, bowel obstruction, and space occupying lesions (masses). The location of the mesenteric abnormality was in the proximal part of mesenteric vessels in 45 cases (72.5%) and in its distal part in 17 cases (27.5%). Malrotation (eight cases), obstruction, and volvulus were the most common causes of a distal abnormality. Conclusions: Mesenteric vessel abnormalities, noted with sonography, may not be exclusive to the diagnosis of malrotation and midgut volvulus. In this cohort, bowel obstruction, diaphragmatic hernia, and space occupying lesions were the other most common anomalies associated with mesenteric vessel abnormalities. In reviewing one-third of mesenteric vessels, abnormalities were only seen in the distal part of vessels; therefore, a thorough examination is warranted.
Collapse
Affiliation(s)
- Seyed Ali Alamdaran
- Akbar Children’s Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Shima Arjmand
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Rahimzadeh Oskooei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
7
|
Dekonenko C, Sujka JA, Weaver K, Sharp SW, Gonzalez K, St Peter SD. The identification and treatment of intestinal malrotation in older children. Pediatr Surg Int 2019; 35:665-671. [PMID: 30810798 DOI: 10.1007/s00383-019-04454-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Intestinal malrotation is often diagnosed in infancy. The true incidence of malrotation outside of this age is unknown. These patients can present atypically or be asymptomatic and diagnosed incidentally. We evaluate the incidence, clinical presentation, ideal imaging, and intra-operative findings of patients with malrotation over 1 year of age. METHODS Retrospective review was conducted in patients older than 1 year, treated for malrotation at a single pediatric tertiary care center from 2000 to 2015. Data analyzed included demographics, presentation, imaging, intraoperative findings, and follow-up. Patients predisposed to malrotation were excluded. RESULTS 246 patients were diagnosed with malrotation, of which 77 patients were older than 1 year of age. The most common presenting symptoms were vomiting (68%) and abdominal pain (57%). The most common method of diagnosis was UGI (61%). In 88%, the UGI revealed malrotation. 73 of 75 were confirmed to have malrotation at surgery. Intra-operatively, 60% were found to have a malrotated intestinal orientation and 33% with a non-rotated orientation. Obstruction was present in 22% with 12% having volvulus. Of those with follow-up, 58% reported alleviation of symptoms. CONCLUSION Despite age malrotation should be on the differential given a variable clinical presentation. UGI should be conducted to allow for prompt diagnosis and surgical intervention.
Collapse
Affiliation(s)
- Charlene Dekonenko
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Joseph A Sujka
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Katrina Weaver
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Susan W Sharp
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Katherine Gonzalez
- Department of Surgery, John Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| |
Collapse
|
8
|
Wu C, Ye K, Wu Y, Chen Q, Xu J, Lin J, Kang W. Variations in right colic vascular anatomy observed during laparoscopic right colectomy. World J Surg Oncol 2019; 17:16. [PMID: 30636641 PMCID: PMC6330569 DOI: 10.1186/s12957-019-1561-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023] Open
Abstract
Background This study aimed to analyze right colonic vascular variability. Methods The study included 60 consecutive patients who underwent laparoscopic radical right colectomy and D3 lymph node dissection for malignant colonic cancer on the ileocecal valve, ascending colon or hepatic flexure (March 2013 to October 2016). The videos of the 60 surgical procedures were collected. Variations of right colonic vascular anatomy were retrospectively analyzed based on 60 high-resolution surgical videos of laparoscopic surgery. Results The superior mesenteric artery and vein were present in all cases; 95.0% (57/60) had the superior mesenteric artery on the left side of the superior mesenteric vein. The ileocolic artery and vein occurred in 96.7% (58/60) and 100% (60/60) of cases, respectively; 50.0% (29/58) had the ileocolic artery passing the superior mesenteric vein anteriorly. Thirty-three (55.0%) cases had a right colic artery, and 2 (3.33%) had a double right colic artery; 90.9% (30/36) had the right colic vein passing anterior to the superior mesenteric artery. Fifty-six (93.3%) cases had a right colic vein; 7 (12.5%) had a right colic vein accompanied by a right colic artery, 66.1% (37/56) had the right colic vein draining into the gastrocolic trunk of Henle, 23.2% (13/56) had the right colic vein directly draining into superior mesenteric vein, and 10.7% (6/56) had one right colic vein draining into the superior mesenteric vein and the other into the gastrocolic trunk of Henle. Fifty-three (88.3%) cases had a gastrocolic trunk of Henle: a gastrocolic trunk in 35.8% (19/53), a gastropancreatic trunk in 9.4% (5/53), and a gastropancreaticocolic trunk in 54.7% (29/53). The frequencies of middle colic artery and vein were respectively 100% (60/60) and 93.3% (56/60). Conclusions Right colonic vascular variations were classified in Chinese patients. Notable findings included a superior mesenteric artery positioned to the right of the superior mesenteric vein and variation in middle colic artery length. This knowledge may be helpful to colorectal surgeons and could potentially help to improve safety by reducing vascular complications during minimally invasive procedures.
Collapse
Affiliation(s)
- Chuying Wu
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Kai Ye
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China.
| | - Yiyang Wu
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Qiwei Chen
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Jianhua Xu
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Jianan Lin
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| | - Wengui Kang
- Department of Tumor Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China
| |
Collapse
|
9
|
Hsu YC, Hsu LS, Huang WS, Weng JC, Chen CW. Short bowel syndrome caused by laparoscopic loop enterostomy of the jejunum in an adult with undiagnosed intestinal malrotation: A case report. Medicine (Baltimore) 2018; 97:e12712. [PMID: 30290673 PMCID: PMC6200473 DOI: 10.1097/md.0000000000012712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
RATIONALE Failure to recognize intestinal malrotation in adults can cause complications during surgeries, especially those with a limited operative field. We report a case of short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation. PATIENT CONCERNS A 72-year-old man underwent a laparoscopic right hemicolectomy and ileocolostomy because of complicated diverticulitis. Six days after the surgery, he received laparoscopic exploration because of anastomotic leak, and a laparoscopic loop ileostomy was also performed as a protective diversion stoma. One month after surgery, he complained of severe diarrhea from the enterostomy after food and water intake. An upper gastrointestinal and small bowel series revealed that the duodenojejunal junction (DJJ) did not cross the midline and there was a short distance between the DJJ and the enterostomy in the right lower quadrant. DIAGNOSES Short bowel syndrome caused by mistaken creation of a loop enterostomy in the jejunum due to undiagnosed intestinal malrotation. INTERVENTIONS Total parental nutrition was used and the loop enterostomy was closed 3 months after the initial surgery. OUTCOMES The patient was discharged uneventfully 2 weeks after the loop enterostomy. LESSONS Intestinal malrotation in adults is often encountered during routine radiological examinations. However, it may cause complications during surgery if ignored. Radiologists should keep in mind that complications may occur if a complete presurgical evaluation of intestinal malrotation is not performed, and surgeons should take caution when performing surgeries, especially those with a limited operative field.
Collapse
Affiliation(s)
- Yin-Chen Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University College of Medicine, Taoyuan
| | - Li-Sheng Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University College of Medicine, Taoyuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan
| | - Wen-Shih Huang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Department of Medicine, College of Medicine, Chang Gung University
| | - Jun-Cheng Weng
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi
- Chang Gung University College of Medicine, Taoyuan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| |
Collapse
|
10
|
Abstract
Ultrasonography (US) is a valuable imaging tool for evaluation of different clinical conditions in children, in general and abdominal conditions, in particular. The interest in US derives primarily from the lack of ionizing radiation exposure, low cost, portability, real-time imaging and Doppler capabilities. In addition, US application requires no preparation or sedation, making it particularly attractive in the pediatric population. Because of these advantages, US has been adopted as the primary imaging tool for evaluation of a number of pediatric abdominal conditions that would have involved the use of ionising radiation in the past, e.g., pyloric stenosis, intussusception and various renal and bladder abnormalities, to name a few. Certain limitations, however, are inherent to US including large body habitus, excessive bowel gas, postoperative state and the learning curve. In addition, pediatric US is particularly challenging as the children are frequently unable to co-operate for breath holding and many of them are crying during the scanning. In the present review, the authors discuss the various applications of US in the evaluation of pediatric abdomen.
Collapse
|
11
|
Gupta L, Saxena AK, Sodhi KS, Mahajan JK, Khandelwal N. Omental infarction: An unusual cause of right iliac fossa pain in children. J Indian Assoc Pediatr Surg 2016; 21:33-5. [PMID: 26862293 PMCID: PMC4721126 DOI: 10.4103/0971-9261.164637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Omental infarction is an uncommon cause of acute abdomen in the pediatric population. We report a case of a 4-year-old male child with right iliac fossa pain. The final diagnosis was made on ultrasound and computed tomography findings. This entity needs to be differentiated from acute conditions like appendicitis, avoiding surgery.
Collapse
Affiliation(s)
- Laxmikant Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai K Mahajan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
12
|
|
13
|
Anticlockwise swirl: a potential pitfall for malrotation. J Pediatr Gastroenterol Nutr 2015; 60:e25. [PMID: 25714584 DOI: 10.1097/mpg.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|